ABNORMAL CONDITIONS OF THE HAND. 



517 



after these operations. Indeed, we feel per- 

 suaded that, in some cases of spina ventosa, 

 (Jig. 229) the tumour may be cut off from 

 a finger or from a me- 

 Fig. 229. tacarpal bone, and that 



although the wound 

 may for a while throw 

 up cartilaginous gra- 

 nulations, still, under 

 proper treatment, the 

 ulcer of the bone will 

 be got to heal kindly. 



Abnormalconditions 

 of the fingers the re- 

 sult of accidents and 

 morbid affections oj'one 

 or more of their consti- 

 tuent structures. We 

 occasionally find that 

 the voluntary power of 

 flexing or extending the 

 joints of the fingers is 

 lost. This loss of 

 power may arise from 

 a great variety of 

 causes; anchylosis of a joint from acute 

 or chronic inflammation; the loss of an ex- 

 tensor or flexor tendon from a similar cause, 

 or from a wound; congenital malformation of 

 the brain; disease or accident affecting this 

 organ, the spinal marrow, or the nerves con- 

 nected with the movements of the upper extre- 

 mity ; any of these may at times be the source 

 of this loss of the voluntary power over the 

 fingers. Under these circumstances, although 

 there may be but little external deformity, 

 sometimes the fingers cannot be flexed; more 

 frequently they cannot be voluntarily extended. 

 An abnormal condition of the fingers, shewing 

 itself in some distortion of these organs, may 

 be traced to causes affecting 1, the skin; 2, 

 the fascia; 3, the theca of the tendons; 4, the 

 tendon itself; and 5, the bone. If a burn pe- 

 netrate the skin on the palmar surface of the 

 hand, a dense cicatrix will be formed ; and much 

 exertion will be necessary, on the part of the 

 surgeon, to oppose successfully the gradual con- 

 traction of the " tissue of the cicatrix." Should 

 contraction take place, notwithstanding these 

 efforts, the functions of the hand will be im- 

 paired, and much deformity will remain. A 

 burn on the back of the hand may be followed 

 by analogous effects. 



There is a peculiar form of contraction of 

 the fingers, which Boyer seems to ascribe (we * 

 believe erroneously) to a shortening of the ten- 

 dons. Adopting the language of the ancients, 

 he denominates the affection "crispatura tendi- 

 num." This contraction of the fingers is never 

 seen in very young persons. Most of those 

 we have known affected by it were adults, who 

 had been for a long time compelled to make 

 laborious use of their hands. The disease will 

 be ordinarily found to commence in a contrac- 

 tion of the little finsrer ; the ring finger is next 

 engaged, and then the middle finger. From 

 day to day the fingers become more contracted, 

 and the power of extending them is lost. When 

 one hand is thus affected, it usually happens 



that the other soon becomes equally engaged. 

 It is remarkable that neither the indicator nor 

 the thumb have ever been seen affected with 

 this disease. 



When we examine the fingers the subjects of 

 this species of contraction (Jig. 230), we find 

 that the first phalanx is moveable on the meti- 

 carpal bone, and is flexed at an angle more or 

 less approaching to a right angle. We can flex 

 it a little more towards the palm ; but to extend 

 it so as to efface the angle is impossible; "a 

 weight," says Dupuytren, "of 150lbs. will not 

 bring the finger into a straight line with its me- 

 tacarpal bone." Boyer says, " our efforts to 

 extend the fingers are resisted to such a degree, 

 that if we continued them they would break 

 before we could force them to yield." 



Fig. 230. 



Contraction of the fingers from disease of tlie palmar 

 fascia. 



This description, however, applies only to the 

 metacarpal joint of the first phalanx, for the last 

 phalanges of each affected finger, though move- 

 able, habitually remain perfectly straight. 



In these cases the integuments of the affected 

 palm and the subjacent fascia seem to be more 

 than naturally thick and consolidated, and we 

 observe the lowest of the natural cutaneous 

 lines of the palm thrown into a very deep 

 crescentic fold, the concavity of which looks 

 towards the fingers, and the convexity towards 

 the wrist joint. W also invariably notice in 

 these cases a rounded projecting chord which 

 passes downwards from the middle of the 

 palm of the hand to the basis of the first 

 phalanx of the contracted finger. This chord 

 feels hard, and is rendered more tense and 

 salient whenever we make an effort to straighten 

 the affected finger. 



When in the living subject we examine care- 

 fully the palmar fascia, and explore, as far as 

 we can, its connexion above with the tendon of 

 the palmaris longus, and below, follow the pro- 

 longations it sends to the lateral aspect of the 

 contracted fingers, we find them all continuous; 

 in a word, when we press upon the tendon of 

 the palmaris longus, we make tense the tendinous 

 digitations above-mentioned. The continuity 

 of all these fibrous structures is thus evident in 



